Provider Demographics
NPI:1992968713
Name:TOBISKA, KATIE
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:TOBISKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 SAN FELIPE RD STE 14
Mailing Address - Street 2:
Mailing Address - City:HOLLISTER
Mailing Address - State:CA
Mailing Address - Zip Code:95023-3035
Mailing Address - Country:US
Mailing Address - Phone:831-245-8968
Mailing Address - Fax:
Practice Address - Street 1:321 SAN FELIPE RD STE 14
Practice Address - Street 2:
Practice Address - City:HOLLISTER
Practice Address - State:CA
Practice Address - Zip Code:95023-3035
Practice Address - Country:US
Practice Address - Phone:831-245-8968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-02
Last Update Date:2019-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
4424Medicare PIN